This document outlines the general pain trajectory of surgical patients. Every surgery is unique, and not all patients follow this generalized trajectory. Some patients take longer to heal than others. Therefore, all content in this document is subject to change based on your progress. If there is a topic in this document that does not match your discussions with Dr. Fuller, do not hesitate to reach out to him to confirm details!
In the period after your surgery, there will likely be some degree of pain. It is important that patients talk with their surgeon before proceeding with surgery, so that realistic goals can be set. The goal of pain control medications and techniques is NOT complete elimination of pain. Rather, the goal is to get the pain to a tolerable level, so that the patient can function and effectively participate in their recovery.
Postoperative pain is usually most severe in the first day or two after surgery, and should gradually decrease. Most patients are very comfortable by their first postop visit (2 weeks after surgery). Many patients do not require narcotic pain medication at all. Of those that do use narcotics, they should not be required beyond the first few days following surgery. There may continue to be pain and swelling for several weeks or months after surgery, but these should be controllable with the listed techniques and non-narcotic medications. The pain should also have an overall downward trajectory; if pain is increasing or becoming severe, contact Dr. Fuller to arrange for reevaluation.
If you have a dressing or cast on after your surgery, it is important to understand the concept of neuroplasticity and how this can affect pain. Our brain is accustomed to receiving a certain number of “pain” signals from your body in a given day. When a cast or dressing is protecting an area for several weeks, you are protecting the area from events that can send these “pain” signals. Your brain notices the difference, and “thinks” that because there are fewer signals, there must be a problem with the nerves to the area. This leads to the nerves becoming more sensitive, to help detect the missing “pain” signals. Once the casts and dressings are removed, these sensitized nerves can send more “pain” signals than they normally would, and can send them during inappropriate situations. This can cause normal everyday activities, even gentle stretching or touching, to seem painful even though no new injury has occurred and no new damage is being done.
I describe all this to reassure you that some degree of hypersensitivity in the area is very normal after being splinted, casted, or otherwise covered. Rest assured that the nerves do gradually return to normal, and that you can help this process along by working on range of motion while these covers are in place, controlling your pain with the techniques described above, and by participating and working hard in therapy!